Occupant Directed Care and Culture Change in Nursing Homes

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Inhabitant Directed Care and Culture Change in Nursing Homes Christine Mueller, PhD, RN, FAAN University of Minnesota School of Nursing Mathy Mezey, EdD, RN, FAAN, Sarah Greene Burger, RN-C, MPH, FAAN Ethel Mitty, EdD, RN Hartford Institute for Geriatric Nursing, New York University College of Nursing Module 3 of Nursing Homes as Clinical Placement Sites for Nursing Students Series

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Acknowledgments This is a joint venture of With support from Grant to the University of Minnesota School of Nursing

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This venture is embraced by: Project Steering Committee View List of Members

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About Module 3 : Resident Directed Care and Culture Change in Nursing Homes Describe the ideas of occupant coordinated care and culture change in nursing homes Compare and complexity the advantages of picking society change nursing homes as clinical position destinations Evaluate a nursing home's appropriation of occupant coordinated care and culture change Explain the contrasts between a culture change nursing home and a conventional nursing home Explain the CMS Artifacts of Culture Change Identify the dangers to medical attendants when working in a culture change nursing home Objectives/Purpose: At the end of this module you will have the capacity to:

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Reasons to Choose a Culture Change Nursing Home as a Clinical Placement Site Expose understudies to a conscious model of care that: Creates a home-like environment Offers an occupant decisions about the planning and way of their care Empowers RNs, LPNs, and nursing associates to structure mind in an adaptable/responsive manner Improves an occupant's feeling of personality and reason

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Resident Care in a Traditional Nursing Home An occupant in a customary nursing home would have: Wake up, dinners and showers on an inflexible/settled calendar Nursing staff who do diverse "errands" e.g. temps; meds; toileting Care directed by nursing home conventions and strategies A room and environment that resembles a "little healing facility," e.g. no little living rooms, few plants, pets confined, constrained accessibility of snacks. Little consideration regarding their passionate and personal satisfaction needs, e.g. what makes them upbeat, connected with A feeling of confinement and depression

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Resident Care in a Culture Change Nursing Home An inhabitant in a culture change nursing home would have: A home-like environment (pets; plants; sustenance accessible day in and day out) Choice regarding: When to get up and go to bed When, where and what to eat How frequently and where to bathe Keeping a pet a similar staff giving and arranging their care: Staff and occupant together choosing the care A care plan that is in the occupant's (e.g. "I") voice Families welcome and taking an interest in care Click to View Information about Nursing Home Comparisons at the Pioneer Network Learn more about Continuum of Person-Directed Culture

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Geriatric Nursing Competencies for Resident Directed Care Click to see the skills created by the Pioneer Network

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Outcomes of Culture Change Nursing homes actualizing society change report upgrades in: Quality (weight ulcers, restriction utilize, catheter utilize) State overview results Staff turnover and less utilization of organization staff Per bed net pay Operating edge Occupancy

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Research Supporting Culture Change is Limited Culture change grabbed hold as "the correct thing to do" without research confirm Creating an exploration base was viewed as backing off the reception of culture change Culture change was started by experts and buyers The few existing examination concentrates on culture change have variable plans and little specimen sizes

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The Path to Resident Directed Care and Culture Change Nursing homes fluctuate in the matter of how they fuse the standards and practices of culture change. Nursing homes contrast in the degree to which they: Create a "familiar" domain Implement practices of occupant decision for sustenance decision, feasting, washing, taking prescriptions Culture change is depicted as an adventure. Reconfigure nursing administrations and make staff strengthening To realize what nursing homes are partaking in the way of life change travel, contact the state's way of life change coalition or Google: "culture change coalition." Click to View CMS Survey and Certification Letter, 4/09

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Defining a "Home Like" Environment Household display: the nonexclusive term Neighborhood : Small units of 8-20 inhabitants Consistent staff task Separate eating and living territories Local (i.e., group) basic leadership Green House : Built from the base up Changes in office estimate, format, inside plan Staffing designs adjusted to reflect occupant needs and inclinations Goal is to take out substantial nursing homes and de-systematize LTC Eden Alternative : a theory of home and practice "Where senior citizens live should be natural surroundings for individuals, not clean foundations." Goal: dispense with the "3 maladies of forlornness, weakness, fatigue." Eden ideas are coordinated into various living models

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Artifacts of Culture Change Artifacts of Culture Change is a CMS apparatus to assess a nursing home's advance from institutional to occupant coordinated care The device has five key areas of culture change: 1. Mind Practices 2. Environment 3. Family and Community 4. Administration 5. Work environment hones Click to Learn more about Artifacts in culture change at the Pioneer Network Click to Learn more about the Development of the Artifacts of Culture Change Tool

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Artifacts of Culture Change 1: CARE PRACTICES Artifacts 24 hour feasting where inhabitants can arrange sustenance from the kitchen 24 hours/day Snacks, drinks accessible at all times Waking and sleep times and washing inclinations and times are picked by the occupant Care arrangements are in the "voice" of the inhabitant, called "I" Care arranges Residents can have their pet live with them Someone is with a withering inhabitant at all times Hartford Institute for Geriatric Nursing, College of Nursing, New York University Nursing Homes as Clinical Training Sites

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Example of a Care Plan in the "Voice" of the Resident For cases of "I" care arranges, see the accompanying connections: "I" Centered Care Plans Message Board "I" Care arrange illustration Riverview Care Center "I" Care arrange case Clark-Lindsey Village

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Artifacts of Culture Change 2: Examples of ENVIRONMENT Artifacts Residents have private rooms or security is improved in shared rooms Nurse's stations are not noticeable Medications are kept in the inhabitant's room Overhead paging framework is utilized just as a part of instances of crisis Personal clothing is done in the region where the inhabitant lives Bathroom mirrors are wheelchair open

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Artifacts of Culture Change 3: Examples of FAMILY and COMMUNITY Artifacts Space for group gatherings to meet with inhabitants welcome to go to Café/eatery accessible for families, occupants and guests Dining range accessible for families to have dinners with their relative Kitchen/kitchenette territory where cooking and heating should be possible

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Artifacts of Culture Change 4: Examples of LEADERSHIP Artifacts Nursing partners go to and take an interest in care arrange meetings Learning circles (or comparable) are utilized as a part of occupant and workforce gatherings Residents and families serve on nursing home quality appraisal/certification councils Community (family/neighborhood) gatherings are held frequently with staff, inhabitants, and families.

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Artifacts of Culture Change 5: Examples of WORKPLACE PRACTICE Artifacts RNs, LPNs, and CNAs reliably work with similar occupants CNAs self-plan Staff not required to wear a uniform or "cleans" Nursing home pays for outside meetings and workshops for CNAs Career stepping stool, work advancement openings Day mind nearby

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Professional Nurse Practice Model Should Underpin Culture Change Nursing Homes

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Nurse Leadership and Culture Change Culture change requires a training and transformational nurture initiative style Nurses have little learning of or involvement in culture change Nurses might be new to this style of administration Nurses might not have been included in making this culture change

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Potential Dilemmas for RNs in Culture Change Potential issues include: Resident hazard/hurt from poor basic leadership RN responsibility when unlicensed staff improperly respect inhabitant demands Loss of an attendant's station and solution trucks when changing to a home domain

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The Pioneer Network Consumer's Guide to Finding a Nursing Home on the Culture Change Journey This guide gives scratch addresses and "listen for" answers, including: How will you become more acquainted with my relative? What is your strategy with respect to nourishment decisions and choices? How would you construct a feeling of group? Source: Pioneer Network http://pioneernetwork.org/Consumers/Guide

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Recap: Key Points about Resident-Directed Care and Culture Change Care rehearses went for enhancing occupant nature of care and personal satisfaction Nursing administration conveyance models Resident and staff basic leadership Care arranges and interdisciplinary group arranging Environmental plans that duplicate a feeling of home Culture change nursing homes can serve as incredible clinical situation locales by presenting understudies to imaginative:

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Please Proceed to the accompanying modules of the Series Nursing Homes as Clinical Placement Sites for Nursing Students Overview of the Project Module 1: An outline of nursing homes by and large Module 2: A diagram of nursing in nursing homes Module 3: Content on inhabitant coordinated care and culture change Module 4: Selecting and organizing clinical positions in nursing homes Module 5: A contextual analysis to help personnel present inhabitant coordinated care and culture change Module 6: Strategies to help nursing homes position themselves as clinical situation .:tsl